Expected impact of applying new 2013 AHA/ACC cholesterol guidelines criteria on the recommended lipid target achievement after acute coronary syndromes.

BACKGROUND: 2013 AHA/ACC guidelines on the treatment of cholesterol advised to tailor high-intensity statin after ACS, while previous ATP-III recommended titration of statin to reach low-density lipoprotein cholesterol (LDL-C) targets. We simulated the impact of this change of paradigm on the achievement of recommended targets. METHODS: Among a prospective cohort study of consecutive patients hospitalized for ACS from 2009 to 2012 at four Swiss university hospitals, we analyzed 1602 patients who survived one year after recruitment. Targets based on the previous guidelines approach was defined as (1) achievement of LDL-C target < 1.8 mmol/l, (2) reduction of LDL-C ≥ 50% or (3) intensification of statin in patients who did not reach LDL-C targets. Targets based on the 2013 AHA/ACC guidelines approach was defined as the maximization of statin therapy at high-intensity in patients aged ≤75 years and moderate- or high-intensity statin in patients >75 years. RESULTS: 1578 (99%) patients were prescribed statin at discharge, with 1120 (70%) at high-intensity. 1507 patients (94%) reported taking statin at one year, with 909 (57%) at high-intensity. Among 482 patients discharged with sub-maximal statin, intensification of statin was only observed in 109 patients (23%). 773 (47%) patients reached the previous LDL-C targets, while 1014 (63%) reached the 2013 AHA/ACC guidelines targetsone year after ACS (p value < 0.001). CONCLUSION: The application of the new 2013 AHA/ACC guidelines criteria would substantially increase the proportion of patients achieving recommended lipid targets one year after ACS. Clinical trial number, NCT01075868.

Sensitivity to Change of the Ultrasound synovitis SONAR Score in RA Patients: Results of the Scqm Cohort

Background/Purpose: Since the end of 2009, an ultrasound scoring call SONAR has been implemented for RA patients as a routine tool in the SCQM registry (Swiss Clinical Quality Management registry for rheumatic diseases). A cross-sectional evaluation of patients with active disease and clinical remission according to the DAS28ESR and the novel ACR/EULAR remission criteria from 2010 clearly indicated a good correlational external validity of synovial pathologies with clinical disease activity in RA (2012 EULAR meeting. Objective: of this study was to evaluate the sensitivity to change of B-mode and Power-Doppler scores in a longitudinal perspective along with the changes in DAS28ESR in two consecutive visits among the patients included in the SCQM registry Methods: All patients who had at least two SONAR scores and simultaneous DAS28ESR evaluations between December 2009 and June 2012 were included in this study. The data came from 20 different operators working mostly in hospitals but also in private practices, who had received a previous teaching over 3 days in a reference center. The SONAR score includes a semi-quantitative B mode and Power-Doppler evaluation of 22 joints from 0 to 3, maximum 66 points for each score. The selection of these 22 joints was done in analogy to a 28 joint count and further restricted to joint regions with published standard ultrasound images. Both elbows and wrist joints were dynamically scanned from the dorsal and the knee joints from a longitudinal suprapatellar view in flexion and in joint extension. The bilateral evaluation of the second to fifth metacarpophalangeal and proximal interphalangeal joints was done from a palmar view in full extension, and the Power-Doppler scoring from a dorsal view with hand and finger position in best relaxation. Results: From the 657 RA patients with at least one score performed, 128 RA patients with 2 or more consultations of DAS28ESR, and a complete SONAR data set could be included. The mean (SD) time between the two evaluations was 9.6 months (54). The mean (SD) DAS28ESR was: 3.5 (1.3) at the first visit and was significantly lower (mean 3.0, SD.2.0, p:_0.0001) at the second visit. The mean (SD) of the total B mode was 12 (9.5) at baseline and 9.6 (7.6) at follow-up (p_0.0004). The Power-Doppler score at entry was 2.9 (5.7) and 1.9 (3.6), at the second visit, p _0.0001. The Pearson r correlation between change in DAS28ESR and the B mode was 0.44 (95% CI: 0.29, 0.57, p_ 0.0001),and 0.35 (95% CI: 0.16, 0.50, p _ 0.0002) for the Power-Doppler score,. Clinical relevant change in DAS (_1.1) was associated with a change of total B mode score _3 in 23/32 patients and a change a Doppler score _0.5 in 19/26. Conclusion: This study confirms that the SONAR score is sensitive to change and provides a complementary method of assessing RA disease activity to the DAS that could be very useful in daily practice.

Length Change of P. C. Concrete Due to Moisture Content, MLR-85-09, 1987

Portland cement concrete is an outstanding structural material but stresses and cracks often occur in large structures due to drying shrinkage. The objective of this research was to determine the change in length due to loss of moisture from placement through complete drying of portland cement concrete. The drying shrinkage was determined for four different combinations of Iowa DOT structural concrete mix proportions and materials. The two mix proportions used were an Iowa DOT D57 (bridge deck mix proportions) and a water reduced modified C4 mix. Three 4"x 4"x 18" beams were made for each mix. After moist curing for three days, all beams were maintained in laboratory dry air and the length and weight were measured at 73°F ± 3°F. The temperature was cycled on alternate days from 73°F to 90°F through four months. From four months through six months, the temperature was cycled one day at 73°F and six days at 130°F. It took approximately six months for the concrete to reach a dry condition with these temperatures. The total drying shrinkage for the four mixes varied from .0106 in. to .0133 in. with an average of .0120 in. The rate of shrinkage was approximately .014% shrinkage per 1% moisture loss for all four mixes. The rate and total shrinkage for all four mixes was very similar and did not seem to depend on the type of coarse aggregate or the use of a retarder.

Barley development as affected by rate of change of photoperiod

The rate of leaf appearance of barley varies substantially with time of sowing. This variation has been related to both the length and the rate of change of photoperiod at the time of plant emergence. An outdoor pot experiment was conducted to test if rate of change of photoperiod directly affects phasic development and rate of leaf emergence of spring barley. Two photoperiod-sensitive cultivars (Bandulla and Galleon) were subjected to five photoperiod regimes: two constant photoperiods, of 14 and 15·5 h, and three different rates of change of photoperiod of c. 2, 9 and 13 min/day from seedling emergence to awn initiation. Photoperiod treatments significantly affected the duration from seedling emergence to awn initiation in both cultivars. Rate of change of photoperiod did not affect the rate of development towards awn initiation independently of the absolute daylength it produced. Although Bandulla had a longer duration than Galleon at any photoperiod regime, the cultivars did not vary in their sensitivity to photoperiod. When this phase was divided into the leaf initiation (LI) and spikelet initiation (SI) phases, it was evident that the sensitivity to photoperiod was not constant, being in general higher during the SI than during the LI phase. However, the magnitude of the change in sensitivity was cultivar-dependent, indicating that sensitivity to photoperiod during the different phases could be under independent genetic control. Final numbers of primordia (leaves together with maximum spikelet number) were negatively affected by increasing photoperiods, but once again, there was no evidence of any effect of the rate of change of photoperiod which was independent of the average photoperiod. Both cultivars showed similar sensitivities for final leaf number but maximum spikelet number was more sensitive to photoperiod in Galleon than in Bandulla. Highly significant linear relationships between leaf number and thermal time were found for all combinations of cultivars and photoperiod regimes (r2 > 0·98). The rate of leaf appearance (RLA) was similar for both cultivars (c. 0·0185 leaves/°Cd) and did not alter during plant development or in response to the change in photoperiod at awn initiation. The range in RLA was greater for Galleon (0·0170–0·0205 leaves/°Cd) than for Bandulla (0·0173–0·0186 leaves/°Cd). Neither of these cultivars exhibited a significant relationship between rate of leaf emergence and photoperiod or rate of change of photoperiod. The lack of significant relationships between RLA and length or rate of change of photoperiod is in contrast with previous reports using time of sowing as a main treatment.

Change of Electricity Distribution Industry: Drivers and Opening Business Opportunities

As a result of the recent regulatory amendments and other development trends in the electricity distribution business, the sector is currently witnessing radical restructuring that will eventually impact the business logics of the sector. This report represents upcoming changes in the electricity distribution industry and concentrates on the factors that are expected to be the most fundamental ones. Electricity network companies nowadays struggle with legislative and regulatory requirements that focus on both the operational efficiency and the reliability of electricity distribution networks. The forces that have an impact on the distribution network companies can be put into three main categories that define the transformation at a general level. Those are: (1) a requirement for a more functional marketplace for energy, (2) environmental aspects (combating climate change etc.), and (3) a strongly emphasized requirement for the security of energy supply. The first point arises from the legislators’ attempt to increase competition in electricity retail markets, the second one concerns both environmental protection and human safety issues, and the third one indicates societies’ reduced willingness to accept interruptions in electricity supply. In the future, regulation of electricity distribution business may lower the threshold for building more weather-resistant networks, which in turn means increased underground cabling. This development pattern is reinforced by tightening safety and environmental regulations that ultimately make the overhead lines expensive to build and maintain. The changes will require new approaches particularly in network planning, construction, and maintenance. The concept for planning, constructing, and maintaining cable networks is necessary because the interdependencies between network operations are strong, in other words, the nature of the operation requires a linkage to other operations.

Otra mirada al tema del cambio de escala: los nuevos espacios de comercio, ocio y turismo = Another look at the theme of the change of scale: new spaces in commerce, leisure and tourism

The technological advances and new organisation of the economy together with a change in ideas in consumer habits andlifestyle that have happened in the last 25 years have placed us in a new state of capitalism. The spatial translation of thisnew state has been immediate and implies among other changes the overcoming of the concept of scale. Commercialspaces and those of leisure and tourism offer us an unbeatable opportunity of exemplifying these changes because they arethe most effected by the new postmodern tendencies

Innovations of ageing and societal transition : Dynamics of change of the socio-technical regime of ageing

The purpose of this dissertation is to examine the dynamics of the socio-technical system in the field of ageing. The study stems from the notion that the ageing of the population as a powerful megatrend has wide societal effects, and is not just a matter for the social and health sector. The central topic in the study is change: not only the age structures and structures of society are changing, but also at the same time there is constant development, for instance, in technologies, infrastructures and cultural perceptions. The changing concept of innovation has widened the understanding of innovations related to ageing from medical and assistive technological innovations to service and social innovations, as well as systemic innovations at different levels, which means the intertwined and co-evolutionary change in technologies, structures, services and thinking models. By the same token, the perceptions of older people and old age are becoming more multi-faceted: old age is no longer equated to illnesses and decline, but visions of active ageing and a third age have emerged, which are framed by choices, opportunities, resources and consumption in later life. The research task in this study is to open up the processes and mechanisms of change in the field of ageing, which are studied as a complex, multi-level and interrelated socio-technical system. The question is about co-effective elements consisting of macro-level landscape changes, the existing socio-technical regime (the rule system, practices and structures) and bottom-up niche-innovations. Societal transitions do not account for the things inside the regime alone, or for the long-term changes in the landscape, nor for the radical innovations, but for the interplay between all these levels. The research problem is studied through five research articles, which offer micro-level case studies to macro-level phenomenon. Each of the articles focus on different aspects related to ageing and change, and utilise various datasets. The framework of this study leans on the studies of socio-technical systems and multi-level perspective on transitions mainly developed by Frank Geels. Essential factors in transition from one socio-technological regime to another are the co-evolutionary processes between landscape changes, regime level and experimental niches. Landscape level changes, like the ageing of the population, destabilise the regime in the forms of coming pressures. This destabilization offers windows for opportunity to niche-innovations outside or at fringe of the regime, which, through their breakthrough, accelerate the transition process. However, the change is not easy because of various kinds of lock-ins and inertia, which tend to maintain the stability of the regime. In this dissertation, a constructionist approach of society is applied leaning mainly to the ideas of Anthony Giddens’ theory of structuration, with the dual nature of structures. The change is taking place in the interplay between actors and structures: structures shape people’s practices, but at the same time these practices constitute and reproduce social systems. Technology and other material aspects, as part of socio-technical systems, and the use of them, also take part in the structuration process. The findings of the study point out that co-evolutionary and co-effective relationships between economic, cultural, technological and institutional fields, as well as relationships between landscape changes, changes in the local and regime-level practices and rule systems, are a very complex and multi-level dynamic socio-technical phenomenon. At the landscape level of ageing, which creates the pressures and triggers to the regime change, there are three remarkable megatrends: demographic change, changes in the global economy and the development of technologies. These exert pressures to the socio-technical regime, which as a rule system is experiencing changes in the form of new markets and consumer habits, new ways of perceiving ageing, new models of organising the health care and other services and as new ways of considering innovation and innovativeness. There are also inner dynamics in the relationships between these aspects within the regime. These are interrelated and coconstructed: the prevailing perceptions of ageing and innovation, for instance, reflect the ageing policies, innovation policies, societal structures, organising models, technology and scientific discussion, and vice versa. Technology is part of the inner dynamics of the sociotechnological regime. Physical properties of the artefacts set limitations and opportunities with regard to their functions and uses. The use of and discussion about technology, contributes producing and reproducing the perceptions of old age. For societal transition, micro-level changes are also needed, in form of niche-innovations, for instance new services, organisational models or new technologies, Regimes, as stabilitystriven systems, tend to generate incremental innovations, but radically new innovations are generated in experimental niches protected from ‘normal’ market selection. The windows of opportunity for radical novelties may be opened if the circumstances are favourable for instance by tensions in the socio-technical regime affected by landscape level changes. This dissertation indicates that a change is taking place, firstly, in the dynamic interactionbetween levels, as a result of purposive action and governance to some extent. Breaking the inertia and using the window of opportunity for change and innovation offered by dynamics between levels, presupposes the actors’ special capabilities and actions such as dynamic capabilities and distance management. Secondly, the change is taking place the socio-technological negotiations inside the regime: interaction between technological and social, which is embodied in the use of technology. The use of technology includes small-level contextual scripts that also participate in forming broader societal scripts (for instance defining old age at the society level), which in their turn affect the formation of policies for innovation and ageing. Thirdly, the change is taking place by the means of active formation of the multi-actor innovation networks, where the role of distance management is crucial to facilitate the communication between actors coming from different backgrounds as well as to help the niches born outside the regime to utilise the window of opportunity offered by regime destabilisation. This dissertation has both theoretical and practical contributions. This study participates in the discussion of action-oriented view on transition by opening up of the socio-technological, coevolutionary processes of the multi-faceted phenomenon of ageing, which has lacked systematic analyses. The focus of this study, however, is not on the large-scale coordination and governance, but rather on opening up the incremental elements and structuration processes, which contribute to the transition little by little, and which can be affected to. This increases the practical importance of this dissertation, by highlighting the importance of very tiny, everyday elements in the change processes in the long run.

A year after Crimea: continuity and change of Finnish-Russian relations reflected in the views of the government officials of Finland and Russia

This thesis discusses the dynamism of bilateral relations between Finland and Russia and their interconnection with wider EU-Russia relations in the sight of the recent conflict in Ukraine. In particular, incorporation of Crimea in the territory of Russia in March 2014 is believed to have triggered a series of disputes between the European Union and Russia and thus, have impacted the course of the bilateral Finnish-Russian relations. The study leans on a premise that there are some historical traditions and regularities in the Finnish foreign policy course towards Russia which make the bilateral Finnish-Russian relations special. These traditions are distinguished and described in the book “Russia Forever? Towards Pragmatism in Finnish/Russian relations” (2008) edited by H. Rytövuori-Apunen. Assuming that the featured traditions take place in modern relations between Finland and Russia, the aim of the thesis is to find out how these traditions reappear during the year shaped by the events in Ukraine. In order to do that, author follows the timeline of happenings around the Ukraine crisis starting with Crimea’s referendum on independence, and exams the way these events were commented on and evaluated by the key government officials and political institutions of Finland and Russia. The main focus is given to the Finnish official discourse on Russia during the study period. The data collection, consisting of mostly primary sources (ministerial press releases and comments, statements, speeches and blog posts of individual policy makers) is processed using the thematic analysis supported by the content analysis. The study reveals that the consequences of the Ukraine crisis have brought, among others, complications to the economic cooperation between Finland and Russia, and have stimulated the increased attention of the Finnish decision makers to the country’s security questions. As a result, the character and importance of some historical regularities of the Finnish foreign policies on Russia, like the Continental Dilemma, have taken new shape.

Managing the change of organizational culture in cross-border mergers and acquisitions: The role of post-acquisition integration in organizational culture change

Over the years, cross-border mergers and acquisitions have become a popular strategic option for variety of firms. Companies often seek rapid growth through acquiring potentially valuable enterprises or attempting to enhance their organization’s profitability by merging with other firms. However, managing the change of organizational culture is a major managerial challenge as companies often confront difficulties when merging two previously autonomous organizational cultures into one, joint organizational culture. Therefore, the purpose of this study is to increase understanding related to the challenges and possibilities concerning the management of organizational culture change in cross-border mergers and acquisitions. The research question “How to manage the change of organizational culture in cross-border mergers and acquisitions?” is analysed in relation to the theories presented in this thesis regarding organizational culture, organizational change and acculturation as well as in relation with the collected empirical data. The research question is divided into three sub-questions according to the following: (1) “What is the role of organizational culture in organizations?”, (2) “How to manage organizational change in mergers and acquisitions?” and (3) “How to manage organizational culture change through acculturation?”. The thesis is conducted as a qualitative case study research including three personal interviews and one group interview. The interviews were conducted as a combination of semi-structured and unstructured interviews. Theories related to organizational culture, the management of change as well as acculturation are studied and further analysed in relation to empirical material collected by the researcher. Research findings indicate that that several factors can influence the success of managing the organizational culture change in cross-border mergers and acquisitions. Factors such as defining the preferred acculturation model prior the merger; managing the resistance of change; open communication; acknowledgement of local culture and cultural differences; involvement of personnel in change processes; as well as the formulation and implementation of comprehensive change plans proved to be important factors with relation to successful management of organizational culture change

Change of Name, 1988

A document with an article of amendment to change the present name of Barnes Wines, Limited to 3273 Ontario Limited.

Theory for the change of bond character in divalent-metal clusters

To determine the size dependence of the bonding in divalent-metal clusters we use a many-electron Hamiltonian describing the interplay between van der Waals (vdW) and covalent interactions. Using a saddle-point slave-boson method and taking into account the size-dependent screening of charge fluctuations, we obtain for Hg_n a sharp transition from vdW to covalent bonding for increasing n. We show also, by solving the model Hamiltonian exactly, that for divalent metals vdW and covalent bonding coexist already in the dimers.

Development and/or change of the notion of permanent object and operative causality: empirical evidence in the first year of life

This study examines the notion of permanent object during the first year of life, taking into account the controversy of two approaches about the nature of change: developmental change and cognitive change. Using a longitudinal/cross-sectional design, tasks adapted of the subscale of permanent object and operative causality of the Uzgiris-Hunt Scale (Uzgiris and Hunt, 1975) (Uzgiris & Hunt, 1975) were presented to 110 infants of 0, 3, 6 and 9 months-old, which reside in three cities of Colombia. The results showed three types of strategies: (a) Not resolution; (b) Exploratory and (c) Resolution, which follow different trajectories in children’s performance. This allows affirming that adaptive conquests of the cognitive development stay together with the variety of strategies. Using strategies reveals adjustments and transformations of action programs that consolidate the notion of permanent object not necessarily with age, but with self-regulatory processes. Empirical evidence contributes to the understanding of the relations between the emergence of novelty in the development and performance variability

A change of climate.

Novela de la escritora inglesa Hilary Mantel que narra la historia de la familia Eldred. Ralph y Anna Eldred viven en una gran casa roja en Norfolk junto a sus cuatro hijos, donde acogen temporalmente a niños con problemas del Este de Londres. Una vida de aparente normalidad que esconde una profunda crisis familiar que tiene sus raíces en su estancia como misioneros en Sudáfrica y Botswana, en las terribles tragedias africanas que han dado forma al resto de sus vidas y que se niegan a quedarse atrás, amenazando con destruir la frágil paz que han logrado construir para ellos y sus hijos..